Abstract
BACKGROUND/OBJECTIVES: The objective of this systematic review and meta-analysis was to compare the risk of recurrence and residual disease between conservative and demolitive treatment in patients diagnosed with cervical adenocarcinoma in situ (AIS). METHODS: Bibliographic databases (CENTRAL, PubMed, Cochrane Database of Systematic Reviews, and Google Scholar) were searched for studies published up to December 2024 reporting both conservative and demolitive treatment outcomes. Exclusion criteria were the lack of outcomes of interest, the reporting of only one treatment modality, and a lack of follow-up. The ROBINS-I tool was used to assess the risk of bias. The evaluated outcomes were AIS or invasive recurrence and AIS or invasive residual after margin positivity at the first excision. A meta-analysis with a fixed-effect model and the Mantel-Haenszel method for risk ratio (RR) with a 95% confidence interval (CI) was performed. Heterogeneity was evaluated with the chi-squared test and quantified with the I2 method. A meta-regression was performed using the year of publication, CKC use, margin positivity, and follow-up duration as predictors. RESULTS: Nineteen studies were included, reporting data about 5934 patients with AIS diagnosis after conization. The meta-analysis showed a higher risk of recurrence as AIS in conservatively treated patients (11 studies, RR = 8.44, 95% CI 3.36-21.19, p < 0.001, I2 = 0.0%, p = 0.73), while no differences were observed in the risk of recurrence as invasive adenocarcinoma (10 studies, RR = 1.67, 95% CI 0.82-3.39, p = 0.16, I2 = 0.00%, p = 0.48). No difference between the two treatment modalities in terms of AIS residual (nine studies, RR = 0.89, 95% CI 0.62-1.26, p = 0.50, I2 = 33%, p = 0.15) or invasive residual (three studies, RR = 0.48, 95% CI 0.09-2.41, p = 0.37, I2 = 0.0%, p = 0.94) after margin positivity at the first excision emerged. The meta-regression showed no association with the predictors. CONCLUSIONS: The safety profile of a conservative treatment for AIS patients seems not to differ from that of a demolitive approach in terms of invasive recurrence or residual, while it seems to be associated with a higher risk of AIS recurrence. Future research should focus on optimizing follow-up strategies to detect AIS recurrences early.